Nearly two weeks after President Donald Trump signed an executive order that aimed to overhaul the childhood vaccine schedule, physician leaders at seven children’s hospitals told Becker’s they are not changing how they recommend or administer vaccines.
“This is a continued assault on expertise and science in general by a group that feels that’s in their best interest,” said Ravi Jhaveri, MD, division head of infectious diseases at Ann & Robert H. Lurie Children’s Hospital of Chicago.
The order calls for splitting the combined MMR shot into three separate vaccines once available, narrows the list of immunizations recommended for all children and directs HHS to develop a plan for administering vaccines at separate visits rather than together. It also pushes states to review their immunization laws and directs the Justice Department to pursue legal action against states that limit religious or medical exemptions. The American Academy of Pediatrics called the order “not only disheartening but dangerous” and said there is no new evidence behind it.
At hospitals in Boston, Chicago, Houston, Kansas City, Mo., Memphis, Tenn., Seattle and Akron, Ohio, physicians said they will continue following the American Academy of Pediatrics’ schedule, arguing the federal order is not grounded in new clinical evidence.
“We are foremost an academic institution, and we are focused on the science of saving kids against catastrophic diseases, and so we owe it to our patients and families to stick with the science,” said Diego Hijano, MD, division director of transplant infectious diseases at Memphis, Tenn.-based St. Jude Children’s Research Hospital. Dr. Hijano pointed to the stakes behind the debate, noting Pennsylvania recorded two measles deaths this year — the state’s first in more than 30 years.
Other physicians pointed to similar warning signs. Mersine Bryan, MD, a pediatric hospitalist at University of Washington School of Medicine and Seattle Children’s, said the country is seeing more kindergarten vaccine exemptions this year than in the past — a shift she called concerning given the current measles outbreak. Dr. Jhaveri also noted that insurers have not followed the administration’s shift in guidance, with coverage for vaccines recommended by the American Academy of Pediatrics continuing uninterrupted. He viewed that as another signal that “these changes aren’t based on any evidence and aren’t necessary.”
The stakes are showing up in hospital operations, too. Luis Ostrosky-Zeichner, MD, chief epidemiology officer at Houston-based Memorial Hermann Health System, said his system used to see a measles exposure about once a year. Now, it is closer to once a month. He cited an estimate that a single cluster investigation can cost a health department more than $300,000 and said Memorial Hermann has shifted from one-off outbreak response to what he called “a continuous, ongoing readiness state,” including new emergency department signage prompting patients with fever and rash to alert staff immediately.
Vandana Madhavan, MD, head of pediatric infectious disease at Mass General Brigham for Children in Boston, said the near-term concern isn’t a change in clinical practice, but the extra time spent reassuring families that, as Dr. Madhavan put it, “practically speaking, nothing has changed.”
That extra communication is showing up differently at each hospital. At St. Jude, staff have trained on a model called AIMS — ask, inquire, mirror, secure — to help clinicians build trust with hesitant families instead of leading with data.
“We’re trying to shift from ‘you need to get the vaccine because the science says so’ because that triggers people and polarizes them,” Dr. Hijano said. “We want to make sure that we are building trust, hearing what our patients’ concerns are without interrupting them, without assuming, and without flooding them with facts and fearful statements.”
At Seattle Children’s, Dr. Bryan’s research has looked at a different point of access: children already admitted to the hospital. Her data found that about half of children admitted to the hospital are missing one or more recommended vaccine doses, but only about 4% receive a vaccine during their stay. The hospital has since built an immunization toolkit for inpatient staff and a communication training program for providers who do not typically bring up vaccines with families, an effort Dr. Bryan said has increased vaccine administrations by 10% this year.
Akron Children’s Hospital took a broader approach, surveying more than 1,000 caregivers nationwide this spring through its Healthy Info, Healthy Kids initiative to understand how families are navigating conflicting health information more broadly, not only around vaccines. The survey found 71% of caregivers believe there is more conflicting medical information today than ever, and 1 in 4 said they had made a healthcare decision for their child that they later regretted because of that confusion. Among caregivers who said they changed their approach after encountering conflicting information, 27% delayed vaccinations and 32% switched primary care physicians.
“Parents are trying to do what’s best for their children, but they’re being asked to navigate more health information and more conflicting viewpoints than ever before,” said Shefali Mahesh, MD, pediatrician in chief at Akron Children’s. Physicians retained high levels of trust: 90% of caregivers said they trust their physicians, and nearly 8 in 10 said children’s hospitals should take a leading role in cutting through conflicting health information. Michael Bigham, MD, chief quality officer at Akron Children’s, framed the hospital’s approach to families as a matter of shared goals rather than persuasion.
“We are directly aligned with caregivers and parents — we want the best health outcomes for their child, just like they want the best health outcomes for their child,” he said.
Not every hospital, however, is seeing heightened concern among families. Angela Myers, MD, an infectious diseases physician at Children’s Mercy in Kansas City, Mo., said she has not noticed a change. “I haven’t seen a change in concerns,” she said. “Overall, the vast majority of patients and families think childhood vaccines are very important.”
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